Comparison of Efficacy and Safety of Midazolam versus Nitrous Oxide as Sedative Agents during Paediatric Dental Treatment: A Systematic Review

ABSTRACT Objective: To identify and study the existing literature on the efficacy and safety of midazolam compared to inhalation of nitrous oxide in children undergoing dental treatment. Material and Methods: Electronic resources such as PubMed Central, Cochrane Database of Systematic Reviews, Lilacs, Science Direct, and SIGLE were thoroughly searched. The title scan was used to find randomised controlled trials reviewed for inclusion by reading the abstract. Studies comparing the sedative, behavioural, and anxiolytic effects and safety in children undergoing dental treatment under midazolam and nitrous oxide inhalation were included. The Cochrane Reviews system software, Revman 5.4.1, was used to assess the quality of the included studies. Results: 11328 articles were identified by screening the electronic databases, of which 10906 were eliminated after titles were read and duplicates were removed. Ten full-text articles were examined, of which three were excluded as they did not match the eligibility criteria. Hence, a total of 7 studies were included. Midazolam and nitrous oxide inhalation were not statistically different in terms of the success of treatment and behaviour modification. However, midazolam showed a deeper level of sedation and resulted in amnesia in more children when compared to nitrous oxide sedation. All of the included studies were found to have a high risk of bias. Conclusion: Though all the studies included showed an increased risk of bias, midazolam and nitrous oxide inhalation seem equally effective sedative agents for controlling behaviour in children undergoing dental treatment. Midazolam shows a deeper sedation level when given orally and produces a higher rate of anterograde amnesia.

Intervención interdisciplinaria para la prevención primaria de la caries en lactantes de 0 a 18 meses / Interdisciplinary intervention for the primary prevention of dental caries in children under 18 months

Introducción: la caries es la enfermedad crónica más frecuente en la infancia. La presencia de caries en la dentición temporal es el principal factor de riesgo para desarrollar caries en la dentición definitiva. La mayoría de los factores de riesgo de la caries son modificables y pueden convertirse en elementos para la prevención y control de la enfermedad. Con el objetivo de reducir la incidencia de caries a la edad de 18 meses se diseña una intervención interdisciplinaria de prevención primaria dirigida a familias con niños que se visitan siguiendo el Protocol d’activitats preventives i de promoció de la salut a l’edat pediátrica (PAPPS). Material y métodos: ensayo clínico no aleatorizado, realizado en dos centros de asistencia primaria de Catalunya desde enero de 2019 hasta junio de 2022. En uno de los centros se diseñó e implementó una intervención educativa de prevención primaria de la caries con consejos y habilidades para las familias. En el otro centro se mantuvo el protocolo habitual de recomendaciones. Se evaluó y comparó la incidencia de caries en ambos grupos a la edad de 18 meses con un modelo de regresión logística estimado con el programa R. Resultados: la incidencia de caries a los 18 meses fue superior en los niños del grupo control (OR = 6,0; IC 95% 1,8-20,2), a pesar de que la valoración del riesgo de caries basada en el sistema llamado Caries Management by Risk Assessment (CAMBRA) indicó mayor riesgo de desarrollo de caries en los lactantes del grupo intervención. Conclusión: la intervención interdisciplinaria de prevención primaria de la caries incorporada en los programas de salud infantil reduce la incidencia de caries en los primeros años de vida. (AU)

Introduction: caries is the most common chronic disease in childhood. The presence of caries in the primary dentition is the main risk factor for developing caries in the permanent dentition. Most of the risk factors for caries are modifiable and can become elements for the prevention and control of the disease. With the goal of reducing the incidence of caries in children at age 18 months, we designed an interdisciplinary primary prevention intervention aimed at families with children who attended routine preventive visits within the PAPPS (“Protocol d’activitats preventives i de promoció de la salut a l’edat pediàtrica”) child health programme. Methodology: non-randomized clinical trial carried out in two primary care centres in Catalonia between January 2019 and June 2022. In one of the centres, an educational intervention for the primary prevention of caries was designed and implemented to provide families with guidance and skills. In the other centre, patients received standard care. The incidence of caries was assessed and compared in both groups at age 18 months by means of a logistic regression model fitted with the R software. Results: the incidence of caries at 18 months was higher in children in the control group (OR=6.0; 95% CI: 1.8-20.2), despite the fact that the caries risk assessment by means of the “Caries Management by Risk Assessment” (CAMBRA) protocol indicated a higher risk of caries in infants in the intervention group. Conclusion: the interdisciplinary primary caries prevention intervention integrated into the child health prevention and promotion programme achieved a reduction in the incidence of caries in early childhood. (AU)

Dental age estimation by assessing the pulp volume of five teeth in a peruvian population using cone beam computed tomography images / Estimación de la edad dental evaluando el volumen pulpar de cinco dientes utilizando imágenes de tomografías computarizadas de haz cónico en una población peruana

Abstract Dental age estimation is very important for individual identification in criminal and civil forensic investigations. One of the methods for age estimation is studying age related changes in pulp volume of teeth. The objective of the current study was to estimate dental age from the pulp volume of five different categories of teeth of a Peruvian sample using cone beam computed tomography (CBCT). Retrospective CBCT records of 231 patients (females (134), males (97), age: 12-60 years) were included in the study, categorized into five different age groups (12-19, 20-29, 30-39, 40-49, 50-59, 60 years and older). Dental pulp volume of five categories of teeth(upper canines, left upper central incisors, left upper first molars, lower left first premolars, first molars) were analyzed using Romexis® 5.3.3.5 software for each patient. There was a reduction in the pulp volume of upper right and left canine with age. The Pulp volume was lowest in people aged 60 years and over. Linear regression analysis of the pulp volume and chronological age showed a coefficient of determination of 30%, suggesting a weak correlation. A weak correlation between dental pulp and age is derived. But, a robust large homogenous sample of teeth in future for different age groups may establish a reliable regression equation.

Resumen La estimación de la edad dental en personas vivas y cadáveres es muy importante para la Odontología Forense, sobre todo en casos de identificación en investigaciones legales y sociales. El objetivo del estudio fue estimación de la edad dental mediante la medición del volumen pulpar de imágenes dentales en tomografía computarizada de haz cónico (TCHC) de pacientes peruanos. Fueron analizadas 231 TCHC de pacientes entre 12 a 60 años a más. (Mujeres (134), hombres (97)) se dividieron en seis grupos de edad (12-19, 20-29, 30-39, 40-49, 50-59, 60 años a más). El análisis volumétrico de la pulpa dental se realizó en un total de 1155 dientes (caninos superiores, incisivos centrales superiores izquierdos, primeros molares superiores izquierdos y primeros premolares inferiores izquierdos), mediante el software Romexis® 5.3.3.5. El análisis de regresión lineal mostró un coeficiente de determinación del 30% que sugiere una correlación débil entre la relación del volumen pulpar de los dientes y la edad. El volumen pulpar de los caninos superiores derecho e izquierdo disminuyó a medida que aumentaba la edad y el volumen pulpar en dientes de personas de 60 años a más fue el más bajo. Sin embargo, se pueden proponer estudios futuros para incluir una gran muestra homogénea de dientes en diferentes categorías y grupos de edad para confirmar la correlación y establecer una ecuación de regresión confiable.

Manejo odontológico en paciente con síndrome de Cornelia de Lange / Dental treatment of a patient with Cornelia de Lange syndrome

El síndrome de Cornelia de Lange (SCdL) es un trastorno genético poco frecuente y se atribuye principalmente a mutaciones en los genes NIPBL, SMC3 y SMC1A. Sus principales características clínicas son múltiples anomalías congénitas, dimorfismo facial, hirsutismo, hipertricosis, retraso psicomotor, discapacidad intelectual, restricción del crecimiento prenatal y postnatal, anomalías de manos y pies, así como malformaciones congénitas que afectan a distintos órganos. En pacientes con SCdL es necesario hacer hincapié en la higiene oral debido a la discapacidad intelectual que puede presentarse y asegurarse de que se realiza una adecuada valoración y saneamiento dental de forma periódica con el fin de prevenir enfermedades bucodentales. El objetivo de este reporte de caso es describir el manejo odontológico de un paciente de 10 años con SCdL y revisar las características clínicas y hallazgos radiológicos presentes en la cavidad oral (AU)

Cornelia de Lange syndrome (CdLS) is a rare genetic disorder and is principally attributed to mutations in the NIPBL, SMC3 and SMC1A genes. The main clinical characteristics are multiple congenital anomalies, facial dimorphism, hirsutism, hypertrichosis, psychomotor retardation, intellectual disability, prenatal and postnatal growth restriction, hand and foot anomalies, as well as congenital malformations affecting different organs. In patients with CDLS, it is necessary to focus on oral hygiene due to the intellectual disability that may be present and to ensure that adequate dental valuation and hygiene is routinely performed in order to prevent oral diseases. The aim of this case report is to describe the dental management of a 10-year-old patient with CDLS and review the clinical characteristics and radiological findings that are present in the oral cavity (AU)

Periodontitis en niños sanos de 3 años: dos casos con seguimiento a 5 años / Periodontitis in healthy 3-year-old children: two cases with 5-year follow-up

Objetivo: La periodontitis en dentición primaria es ex- cepcional en niños sin enfermedades sistémicas. El objetivo de este informe es describir las características clínicas y ra- diográficas de dos casos de niños de 3 años sistémicamente sanos con periodontitis, y su tratamiento con seguimiento a 5 años. Casos clínicos: En ambos casos, a los 3 años de edad los niños fueron derivados al especialista en periodoncia por su odontopediatra debido a la pérdida muy temprana de inci- sivos inferiores. El examen clínico y radiográfico mostró pér- dida de inserción clínica, pérdida ósea y movilidad dental en otros incisivos superiores e inferiores. Se realizó la intercon- sulta médica y se descartó que los niños padecieran enferme- dades relacionadas con el diagnóstico de periodontitis como manifestación de una enfermedad sistémica. El tratamiento consistió en la instrucción de medidas de higiene bucal que debían ser ejecutadas por los padres, ins- trumentación subgingival, antisépticos locales, medicación antibiótica sistémica y mantenimiento periodontal. No se rea- lizaron extracciones como parte del tratamiento. En ambos casos uno de los incisivos presentes al momento de la con- sulta se perdió prematuramente, antes de los 4 años. El resto de los incisivos primarios cumplieron su ciclo normal. Luego de 5 años de seguimiento, a la edad de 8 años, ambos niños presentaban los incisivos y los primeros molares permanentes periodontalmente sanos y el resto de los dientes primarios sin signos de periodontitis (AU)

Aim: Periodontitis in primary dentition is exceptional in children without systemic diseases. The objective of this article is to describe the clinical and radiographic charac- teristics of two cases of systemically healthy 3-year-old chil- dren with periodontitis, and their treatment, with a 5-year follow-up. Clinical cases: In both cases, at 3 years of age, the chil- dren were referred to a periodontic specialist by their pediat- ric dentist, due to the very early loss of lower incisors. Clin- ical and radiographic examination showed loss of clinical attachment, bone loss and dental mobility in other upper and lower incisors. A medical consultation was carried out and diseases related to the diagnosis of periodontitis as a mani- festation of a systemic disease were ruled out. The treatment consisted of instruction on oral hygiene measures that had to be carried out by the parents, subgingival instrumentation, local antiseptics, systemic antibiotic medication, and perio- dontal maintenance. No extractions were performed as part of the treatment. In both cases, one of the incisors present at the time of consultation was lost prematurely, before the age of 4 years. The rest of the primary incisors completed their normal cycle. After 5 years of follow-up, at the age of 8 years, both children showed periodontally healthy incisors and first permanent molars, and the rest of the primary teeth without signs of periodontitis (AU)

Impact of the COVID-19 pandemic on pediatric Medicaid dental claims in Arizona.

OBJECTIVES: To examine the role COVID-19 had on access to dental services among children in Arizona by comparing paid pediatric dental claims made before and during the pandemic. METHODS: In a retrospective descriptive study, we examined Medicaid paid claims for dental services among pediatric patients from March through December 2019 and during the outbreak in 2020. Using dental claims data obtained from the Centers for Health Information and Research at Arizona State University (ASU), we analyzed Medicaid (Arizona Health Care Cost Containment System [AHCCCS]) reimbursed dental services. RESULTS: During the COVID-19 pandemic, paid preventive dental claims for children aged birth to 21 years decreased in 2020 compared to the same time period in 2019. Pediatric patients in Arizona utilized fewer dental services and had less access to credentialed Medicaid dental providers during the pandemic. Further, rural counties had statistically significant fewer preventive, minor restorative, major restorative, and endodontic claims compared to urban counties. Arizona rural counties also had fewer providers who were paid $10,000 or more per year during 2020 than in 2019. CONCLUSIONS: COVID-19 has had a detrimental impact on pediatric dental service utilization. While dental services were provided during the COVID-19 pandemic, preventive and restorative dental claims dropped for rural Arizona children aged birth to 21 years. This reveals potential negative impacts on oral health. Further research should examine the direct and indirect impact the COVID-19 pandemic has had on dental service utilization and oral health for the general pediatric population.

Investigating the scope and costs of dental treatment provided under general anaesthesia among children with congenital heart disease.

AIM: To identify the types of dental treatment provided under general anaesthesia for children diagnosed with congenital heart disease (CHD), quantify the costs within a publicly funded tertiary paediatric hospital setting and identify factors which affect the cost. METHODS: A retrospective analysis of dental records (July 2015 to June 2019) was conducted for children with CHD who had undergone a dental general anaesthetic procedure at The Children's Hospital at Westmead, Australia. Patient and treatment-related information were collected, and a costing analysis was performed on 89 dental general anaesthetic procedures. RESULTS: Mean age at the time of the general anaesthetic was 8.15 years. About 27% of children with CHD had a history of dental infection. Dental extractions and restorations comprised the majority of treatments provided, with extractions performed in 86% of procedures. The mean number of days in hospital was 1.43 and the mean cost was $4395.14. The cost was significantly greater when children presented with a facial swelling compared to any other reason. CONCLUSIONS: Dental extractions are performed in the majority of general anaesthetics. Not only is there an economic burden to the public health system in providing dental treatment under general anaesthesia for children with CHD, the health impacts also appear to be substantial. A considerable proportion required overnight hospitalisation and days in hospital was strongly related to the cost of the dental general anaesthetic. Systematic referral pathways for accessing dental care are an important consideration for children with CHD.

Percepção dos alunos de graduação em Odontologia da Universidade de Brasília acerca da escolha de técnicas de manejo comportamental em Odontopediatria / Percepción de estudiantes de la carrera de Odontología de la Universidad de Brasilia sobre la elección de técnicas de manejo de conducta en Odontopediatría / Perception of undergraduate Dentistry students at the University of Brasília about the choice of behavioral management techniques in Pediatric Dentistry

O objetivo deste estudo foi analisar a aceitação das técnicas de manejo de comportamento infantil por estudantes de primeiro, sexto e nono semestres de um curso de graduação em Odontologia, e a influência que as disciplinas ministradas podem exercer sobre esta. Para isso, foi aplicado um questionário (n=55) contendo questões sobre técnicas de orientação comportamental em Odontopediatria. A aceitação sobre as mesmas, foi avaliada por meio de escala Likert. O teste H de Kruskal-Wallis foi utilizado para avaliar diferença entre os três grupos de estudantes seguido do teste de Dunn. Além disso, foi realizada a correlação de Spearmanpara avaliar possíveis fatores de confusão. De forma geral, notou-se que as técnicas básicas foram mais aceitas entre todos os estudantes, já as técnicas de controle de voz, estabilização protetora e as farmacológicas foram menos aceitas. Os participantes do nono semestre aceitaram mais em média "estabilização protetora pais/equipe", "controle de voz"e "estabilização protetora wrap", e menos "presença permitida dos pais" e "recompensa prometida" em relação aos do primeiro semestre. Em comparação ao sexto, os alunos do nono semestres tiveram menor aceitação para "presença permitida dos pais", "recompensa prometida" e "explicar que pode envolver dor", e maior para "estabilização protetora pais/equipe" e "estabilização protetora wrap". A única técnica que demonstrou diferença entre o primeiro e sexto semestres foi "não deixar falar" com menor aceitabilidade entre os estudantes do sexto semestre. A posição do aluno no percurso curricular parece, portanto, influenciar na aceitação das técnicas de manejo comportamental usadas na Odontopediatria (AU).

El objetivo de este estudio fue analizar la aceptación de técnicas de manejo de la conducta infantil por parte de estudiantes de primero, sexto y noveno semestre de la carrera de Odontología, y la influencia que las materias impartidas pueden tener en esto. Para ello se aplicó un cuestionario (n=55) que contenía preguntas sobre técnicas de orientación conductual en odontopediatría. La aceptación de los mismos se evaluó mediante una escala Likert. Para evaluar las diferencias entre los tres grupos de estudiantes se utilizó la prueba H de Kruskal-Wallis seguida de la prueba de Dunn. Además, se realizó la correlación de Spearman para evaluar posibles factores de confusión. En general, se observó que las técnicas básicas fueron más aceptadas entre todos los estudiantes, mientras que el control de la voz, la estabilización protectora y las técnicas farmacológicas fueron menos aceptadas. Los participantes del noveno semestre aceptaron más en promedio "estabilización protectora de padres/equipo", "control de voz" y "estabilización protectora envolvente", y menos "presencia parental permitida" y "recompensa prometida" en comparación con los del primer semestre. En comparación con el sexto, los estudiantes del noveno semestre tuvieron una menor aceptación de "presencia parental permitida", "recompensa prometida" y "explicar que puede implicar dolor", y mayor de "estabilización protectora padres/equipo" y "envoltura protectora de estabilización". La única técnica que demostró una diferencia entre el primer y el sexto semestre fue "no dejar hablar" con menor aceptabilidad entre los estudiantes del sexto semestre. Por lo tanto, la posición del estudiante en el plan Percepção dos alunos de graduação em Odontologia da Universidade de Brasília acerca da escolha de técnicas de manejo comportamental em Odontopediatria de estudios parece influir en la aceptación de las técnicas de manejo conductual utilizadas en odontología pediátrica (AU).

This study aimed to analyze the acceptance of undergraduate students in the first, sixth, and ninth semesters about the child behavioral management techniques and to explore the potential influence of the curriculum path on their perception. An online questionnaire (n=55) with questions about mental guidance techniques in Pediatric Dentistry was applied. Their accessibility was assessed using a Likert scale. The Kruskal-Wallis and the Dunn testwere used to analyze the difference between the three groups of students. Spearman's correlationwas used to analyze confounding factors. In general, all students exhibited greater acceptance of basic techniques when compared with voice control, protective stabilization, and pharmacological techniques. Participants in the ninth semester showed greater acceptance of "parent/team protective stabilization", "voice control" and "wrap protective stabilization" techniques, and less acceptance of "parental presence/absence" and "promised reward" compared to the first semester. Compared to the sixth, students in the ninth semester had greater acceptance of "parent/team protective stabilization" and "wrap protective stabilization" techniques and less acceptance of "parental presence/absence", "promised reward" and "explain that it may involve pain". "Don't let people talk" was the only technique that demonstrated a difference between the first and sixth semesters, with lower acceptance among students in the sixth semester. The student's semesters seem, therefore, to influence the acceptance of behavioral management techniques used in Pediatric Dentistry (AU).

Practice Patterns Among Dentist Anesthesiologists for Pediatric Patients with Autism Spectrum Disorders.

PURPOSE: The purpose of this study was to evaluate practice patterns among dentist anesthesiologists for pediatric patients with autism spectrum disorders (ASD) undergoing sedation for dental procedures. METHODS: An electronic nationwide survey was delivered to all members of the American Society of Dentist Anesthesiologists. The survey assessed provider training and comfort in treating pediatric patients with ASD, perioperative procedures for children with and without ASD, and preferred educational resources for the perioperative management of pediatric patients with ASD. RESULTS: Respondents were 114 dentist anesthesiologists and residents (33.3 percent response rate). Respondents indicated a high comfort level for managing pediatric patients with ASD for sedation (mean equals 91.9±14.74 [SD] percent). The average number of patients with ASD who respondents treat per week was 3.48±2.44). Providers reported making scheduling and staffing accommodations for patients with ASD. More than half of respondents reported no difference between patient groups in medication dosing for sedation and medication regimens used intraoperatively; however, only 43.9 percent of providers indicated using equivalent preoperative medication regimens for both patient groups, and providers reported increased usage of preoperative anxiolytic techniques with patients with ASD. Importantly, 87.7 percent of respondents reported the same incidence of adverse events during the perioperative period between groups. CONCLUSIONS: Findings from this survey suggest there are both similarities and differences in how dentist anesthesiologists practice with pediatric patients with and without autism spectrum disorders. Additional research is warranted to measure the clinical benefits of modified practices for patients with ASD and identify best practices for this vulnerable population.

Evaluating childsmile, Scotland's National Oral Health Improvement Programme for children.

In the early 2000s, a Scottish Government Oral Health Action Plan identified the need for a national programme to improve child oral health and reduce inequalities. 'Childsmile' aimed to improve child oral health in Scotland, reduce inequalities in outcomes and access to dental services, and to shift the balance of care from treatment to prevention through targeted and universal components in dental practice, community and educational settings. This paper describes how an embedded, theory-based research and evaluation arm with multi-disciplinary input helps determine priorities and provides important strategic direction. Programme theory is articulated in dedicated, dynamic logic models, and evaluation themes are as follows: population-level data linkage; trials and economic evaluations; investigations drawing from behavioural and implementation science; evidence reviews and updates; and applications of systems science. There is also a growing knowledge sharing network internationally. Collaborative working from all stakeholders is necessary to maintain gains and to address areas that may not be working as well, and never more so with the major disruptions to the programme from the COVID-19 pandemic and response. Conclusions are that evaluation and research are synergistic with a complex, dynamic programme like Childsmile. The evidence obtained allows for appraisal of the relative strengths of component interventions and the reach and impact of Childsmile to feed into national policy.

Deep Sedation for Dental Care Management in Healthy and Special Health Care Needs Children: A Retrospective Study.

BACKGROUND: Very young children, and those with disabilities and extensive oral pathology, who cannot be treated in the dental chair, require deep sedation or general anesthesia for dental treatment. OBJECTIVE: The aim of this study is to describe and compare the oral health status in healthy and SHCN children and the treatments performed under deep sedation on an outpatient basis with a minimal intervention approach, and their impact on quality of life. METHODS: A retrospective study between 2006 and 2018 was made. A total of 230 medical records of healthy and SHCN children were included. The data extracted were age, sex, systemic health status, reason for sedation, oral health status before sedation, treatments administered during sedation, and follow-up. The quality of life after deep sedation of 85 children was studied through parental questionnaires. Descriptive and inferential analyses were made. RESULTS: Of the 230 children, 47.4% were healthy and 52.6% were SHCN. The median age was 7.10 ± 3.40 years (5.04 ± 2.42 in healthy children and 8.95 ± 3.09 in SHCN children). The main reason for sedation was poor handling in the dental chair (99.5%). The most frequent pathologies were caries (90.9%) and pulp pathology (67.8%). Healthy children had more teeth affected by decay and with pulp involvement. Patients aged < 6 years received more pulpectomies and pulpotomies. After treatment, parents stated that children were more rested and less irascible, ate better, increased in weight, and had improved dental aesthetics. CONCLUSIONS: Differences in treatments carried out did not depend on the general health status or the failure rate but on age, with more pulp treatments in healthy children who were younger, and more extractions near to the age of physiological turnover in children with SHCN who were older. Intervention under deep sedation with a minimally invasive treatments approach met the expectations of parents and guardians, as it improved the children's quality of life.

Time to complain about pain: Children's self-reported procedural pain in a randomised control trial of Hall and conventional stainless steel crown techniques.

BACKGROUND: Children's pain in dentistry has undesirable short- and long-term consequences; therefore, less invasive treatments merit consideration. AIM: To investigate procedural pain scores for two treatments for carious primary molars in New Zealand primary care. DESIGN: This study was a split-mouth randomised control trial, with secondary outcome analysis. Children (4-8 years) with proximal carious lesions on matched primary molars had one tooth treated with the Hall technique (HT) and one treated with a conventional stainless steel crown (CT); treatment type and order of treatment were randomly allocated (allocation concealment). The Wong-Baker self-report pain scale measured pretreatment dental pain, procedural pain at each treatment and post-operative pain. RESULTS: Data were analysed for 103 children: 49 children had the HT first and 54 children had the CT first. Procedural pain scores did not differ by treatment type, with 71.8% and 76.7% of children reporting low pain for the HT and the CT, respectively. Fewer children reported low procedural pain for the second treatment than the first (p = .047). Most children reported low procedural pain for both treatments (58.3%), although 41.7% experienced moderate-high procedural pain with at least one treatment. CONCLUSIONS: The HT caused pain for as many children as the CT. There is an opportunity for better dental pain management in this setting.

Sociobehavioural Factors Associated With Child Oral Health During COVID-19.

OBJECTIVES: The aim of this study was to identify the sociobehavioural factors that influenced children's oral health during the COVID-19 pandemic. METHODS: The online cross-sectional study was conducted in Al Jouf Province in the northern region of Saudi Arabia. A total of 960 parents of children aged 5 to 14 years were invited by multistage stratified random sampling. Descriptive, multinomial, and multiple logistic regression analyses were performed to estimate odds ratios and determine the relationship between independent and dependent variables. P < .05 was considered statistically significant. RESULTS: Of the 960 participants, 693 (72.1%) reported that their child had 1 or more untreated dental decay. The children of uneducated parents were 1.6-fold more likely to have 1 or more untreated dental decay (adjusted odds ratio [AOR], 1.66; 95% CI, 0.74-3.73; P < .001). The children of unemployed parents were 4.3-fold more likely to have a financial burden for a child dental visit (AOR, 4.34; 95% CI, 2.73-6.89; P < .001). Parents from a rural area were 26.3-fold more likely to have spent a lag period of over 2 years since their child's last dental visit (AOR, 26.34; 95% CI, 7.48-92.79; P < .001). Nursery-level children were 5.4-fold more likely to need immediate care (AOR, 5.38; 95% CI, 3.01-9.60; P < .001). CONCLUSIONS: The present study demonstrated a very high prevalence of 1 or more untreated dental decay in our cohort. Children of rural areas, uneducated, unemployed, widow/divorced, low- and middle-income parents and nursery school children were linked to poorly predictive outcomes of child oral health during the pandemic.

Parents' perceptions and concerns regarding pediatric dental care under general anesthesia in Riyadh (Saudi Arabia): a cross-sectional study.

The prevalence of dental caries in Saudi children is estimated to be 80% for primary dentition and 70% for permanent dentition. Dental treatment under general anesthesia (GA) might be recommended for children with uncooperative behavior or complicated dental treatment requirements. Despite its advantages, some parents have concerns regarding this approach. Nonetheless, little is known about Saudi parents' perceptions and concerns regarding pediatric dental treatment under GA. The main objective of this study was to determine parents' concerns and perceptions on pediatric dental treatment under GA in Saudi Arabia. It is a cross-sectional survey study. The inclusion criteria were: Arabic-speaking parents of healthy children aged 1-14 years referred to GA screening for dental treatment in a hospital. The final study cohort comprised 319 participants. The first part of the questionnaire included the children's and parents' demographic and clinical input, while the second part comprised the parents' perceptions and concerns. The survey was distributed in the dental office during GA screening visits. Our findings revealed that most parents were concerned about possible GA-related complications (78%), followed by postoperative pain (51%), intravenous line and cannula (49%) and coma or death (46%). This study highlights that most Saudi parents were concerned about the use of GA in pediatric dental treatment and the need for more awareness regarding the risks, benefits and expected outcomes of pediatric dental care under GA.

Access to dental care for children with special health care needs: a cross-sectional community survey within Jeddah, Saudi Arabia.

The aim of this study was to investigate the level of dental care access among children with special health care needs (CSHCN) in Jeddah, Saudi Arabia and the barriers hindering this access. Data of this cross-sectional study were obtained from self-administered surveys distributed through seven CSHCN centers. Children with autistic spectrum disorder (ASD), Down syndrome, cerebral palsy, and developmental delay were included. Univariate and bivariate analyses were conducted to describe the data. A total of 602 study participants were included in the analyses. Only 24.9% of the participated caregivers routinely visited the dentist for their CSHCN. Half of CSHCN caregivers found difficulties obtaining dental treatment. This trend was significantly greater in 12-18 years old children (p = 0.013) and in families commuting for more than one hour to dental clinics (p = 0.045). The most common reported barrier was fear of the dentist (61.6%) followed by child uncooperativeness (37.8%) and treatment costs (27.8%). CSHCN lack sufficient dental care for a variety of reasons, primarily fear of dentists, child uncooperativeness, and treatment costs. Dentists require more training and education to facilitate better access to dental care for CSHCN.

The Impact of Preventive Dental Services on Subsequent Dental Treatment for Children in Medicaid.

OBJECTIVE: The goal of this study was to use claims data linked with community-level measures to evaluate the impact of preventive services on the time to subsequent restorative, advanced restorative, and complex dental treatment among children enrolled in the Virginia Medicaid program. METHODS: Four data sources were used (dental claims, eligibility files, American Community Survey, and Area Health Resource Files) for fiscal years 2011 to 2018. The outcomes of interest were time to first treatment services from birth. The treatment outcomes were basic restorative treatment, advanced restorative treatment, or complex treatment. The independent variable was a preventive service prior to a treatment service. Time-to-event curves were estimated and compared using a log-rank test. Propensity score-matched univariate and multivariate Cox proportional hazards frailty models with an inverse probability censoring weighting correction estimated hazard ratios (HRs) for treatment outcomes comparing use of preventive services while controlling for patient demographic, geospatial, and county-level socioeconomic status measures. RESULTS: The analysis included 430,594 children (10,204,182 claims). A log-rank test showed significant differences (P < 0.001) between the times to treatment of those who had a preventive service and those who did not have a preventive service prior to a treatment service. Both Kaplan-Meier curves and the adjusted HR (1.88; 95% confidence interval [CI], 1.46-2.15) indicated that children without preventive services were more likely to have basic restorative treatment at an earlier age along with advanced restorative treatment (HR, 1.52; 95% CI, 1.28-1.80) and complex treatment (HR, 2.13; 95% CI, 1.68-2.61). CONCLUSIONS: In a population of Medicaid-enrolled children, children who did not receive preventive services were significantly more likely to have treatment at an earlier age than those who did receive preventive services. KNOWLEDGE TRANSFER STATEMENT: This study examines the impact of the utilization of preventive dental services since birth and the subsequent dental treatment for children enrolled in a dental Medicaid program. This study also examines the influence of preventive care on dental complexity of treatment for these children. Findings can inform federal and state policy planning of dental Medicaid programs as well as interventions to improve referral systems for the early use of preventive dental services and the establishment of a dental home.

"The pediatric dentist is different": A qualitative study of young children's caregivers' experiences of oral health care in the Galapagos Islands.

BACKGROUND: Little is known about factors influencing children's access to and use of oral healthcare services in the Galapagos Islands, a resource-limited setting. AIM: We sought to understand caregivers' experiences and factors influencing their children's use of dental services on San Cristobal Island in the Galapagos Archipelago. DESIGN: A community-based qualitative interview study was carried out among 25 caregivers of children aged 6 months to 10 years. Participants were recruited via a random walk door-to-door approach in 10 neighborhoods, and interviews were conducted by a trained research assistant who is native of the Galapagos Islands. We employed a grounded theory-based qualitative data analysis based on inductive coding to identify and report major emerging themes and illustrative participant quotes. RESULTS: Two major themes emerged related to children's oral health care. Participants expressed their preference for care provided by paediatric versus general dentists and recognized the important role of school-based dental care programs, acknowledging their strengths and weaknesses. CONCLUSIONS: Participants' lived experiences were informative and helped improve our understanding of factors influencing children's use of dental services in the Galapagos Islands. Above and beyond their local relevance, these themes and insights are likely applicable to other global communities that experience similar barriers of access to oral healthcare services.